Prevention of HIV infection in the absence of a vaccine

Abstract

Most approaches to prevent sexual transmission of HIV among adults, such as behavior change and vaccine development, have been unsuccessful after more than 25 years of research. Conversely, the development of drugs to inhibit HIV replication for the treatment of AIDS has been very successful. The same drugs, when used in combination, are very effective to prevent transmission from pregnant, HIV-infected women to their infants or from HIV-infected adults to their uninfected partners. In both instances, the drugs appear to work by reducing HIV levels in body fluids. The HIV-1C epidemic in southern Africa is associated with high prevalence. The high transmission rates are in turn associated with extended high viral loads after early infection. We propose a new strategy for reducing incidence in high-prevalence communities by targeting a test-and-treat program to those with high viral loads. To ascertain effectiveness, viral genetic linkage will be used to estimate the proportion of infections originating in villages receiving the prevention intervention.